| NPI | 1578903662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX TP10045434) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 53922) |
| Enumeration Date | 2013-07-03 |
| Last Update Date | 2017-03-07 |